Provider Demographics
NPI:1225136054
Name:KLEIN, RICHARD E (DDS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:E
Last Name:KLEIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3665 E 11 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-4300
Mailing Address - Country:US
Mailing Address - Phone:586-573-0438
Mailing Address - Fax:586-573-0186
Practice Address - Street 1:3665 E 11 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-4300
Practice Address - Country:US
Practice Address - Phone:586-573-0438
Practice Address - Fax:586-573-0186
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901009174122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI40114050Medicaid
M10630001Medicare PIN